Balance problems and vertigo in MS

Like all MS symptoms, problems with balance, dizziness and vertigo affect people differently, and vary from day to day. You might have a dizzy spell from time to time, your balance problems might result in you swaying when you walk, or you might need to move with more care than before to avoid losing your balance.

The causes are complex, but once the problem has been investigated, there are ways to get help. Many people find effective ways to improve their balance and feel more confident about getting around.

Dizziness and vertigo – what’s the difference? 

Dizziness with MS is a common symptom, sometimes described as feeling lightheaded. Some people experience vertigo, which is the feeling that you or everything around you is spinning. This could make you feel nauseous as well as unsteady on your feet. MS is not the only cause of dizziness or vertigo. So finding the cause will help find the way to treat or manage it.  

What causes balance problems with MS?

MS can cause balance problems in different ways. Good balance needs lots of parts of your body working together effectively, and MS can disrupt one or more of these. Balance needs:

• Inputs – the information we get from our eyes, our inner ear and sensory nerves all over the body 
• Processing – the way our brain and spinal cord react to the inputs
• Outputs – how our body moves and adjusts 

MS can affect all three. For example, input messages from the eyes might be misleading. The brain might be slightly slower at processing the message. And the output message to muscles might not control them smoothly.

MS can affect balance inputs 

• Eyesight - problems like blurring or double vision can give confusing information to the brain. That’s because it uses this input to work out where the body is in relation to the world around it. Eyesight problems don’t usually upset balance on their own, but they can have an impact. 
• The inner ear – the inner ear constantly updates your brain about the angle and position of your head. If MS affects messages between your inner ear and the brain, the information can be disrupted or missing. That can add to balance problems and can cause dizziness or vertigo.
• Sensory changes – there are sensors all over your body, giving the brain information on pressure, position and movement. Changes in sensation like numbness or tingling can mean the brain gets inaccurate information when it tries to balance your body.

MS can affect balance processing 

The way your brain processes balance information is complex and involves different parts of the brain. So there won’t always be a clear link between areas of MS activity in the brain and balance problems. But as an example, MS nerve damage in the parts of the brain called the cerebellum and the brainstem can cause problems with dizziness and vertigo. 

MS can affect balance outputs 

MS can cause a wide range of symptoms that can have an effect on balance, including difficulties with coordination, tremor and muscle weakness, stiffness or spasms.

These symptoms may mean that your muscles aren’t able to respond properly to the instructions being sent to them by your brain.  A weak or stiff muscle might not move to the desired position, or may get there too slowly. If this combines with misleading information about where the muscle is, you may find it harder to balance yourself.

MS relapses and balance

If you get relapses with your MS, that might cause balance problems or make them get worse. Treating the relapse – usually with steroids – could improve the balance problems. 

Treating other symptoms might also help with balance. For example, if you have worse fatigue or muscle stiffness with the relapse.  

Some people’s balance is affected when their body temperature rises. For example, because of an infection. So treating the infection can help treat the balance issue. 

It may not be your MS

There are other common causes of balance problems that can affect anyone, whether or not they have MS. These include:

• inner ear infections – which can cause dizziness, vertigo and nausea
• positional vertigo – a spinning sensation caused by particular head movements
• side effects of medication

All of these causes are treatable. But you need to know what’s causing your balance problems before they can be treated. If you notice changes in your balance, speak to your GP – it’s important to have any symptoms properly investigated.